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Published on: June 24, 2018
Prosthetic and Biological Complications of Metal-Zirconia versus Metal-Acrylic Implant-Supported Screw-Retained
Dusan Marinkovic1, Rodrigo Gutiérrez1, Marcos Frey1
1DDS. Professor, Postgraduate Program in Oral and Maxillofacial Implantology, School of Dentistry, Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
Background:
Full-arch implant-supported screw-retained prostheses are widely used for the rehabilitation of edentulous patients. Conventional metal-acrylic hybrid prostheses have demonstrated acceptable clinical outcomes, however, mechanical complications, prosthetic wear, and biological issues remain concerns. Monolithic zirconia prostheses with a metallic substructure have been proposed as an alternative, potentially improving long-term clinical performance.
Material And Methods:
A systematic review and meta-analysis were conducted following predefined eligibility criteria. A comprehensive search of CENTRAL, PubMed, Embase, and Epistemonikos databases was performed for studies published between 2000 and 2025. Non-randomized clinical studies with a minimum follow-up of 1 year comparing full-arch implant-supported screw-retained metal-zirconia prostheses with metal-acrylic prostheses were included. Fully monolithic zirconia restorations, partial fixed prostheses, and non-full-arch rehabilitations were excluded. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence was evaluated according to the GRADE approach. Quantitative synthesis was conducted when appropriate.
Results:
Twelve studies fulfilled the inclusion criteria, with eleven included in the meta-analysis. Metal-zirconia prostheses showed significantly lower prosthetic wear (RR=0.29; 95% CI, 0.14-0.59) and a reduced risk of peri-implantitis (RR=0.67; 95% CI, 0.47-0.96). Marginal bone loss favored metal-zirconia prostheses (SMD=0.36). Trends toward improved prosthesis survival (RR = 1.05) and reduced prosthesis loss (RR = 0.09) were observed. No significant differences were found regarding implant survival, framework fractures, esthetics, or speech. Most studies exhibited moderate to critical risk of bias, mainly due to confounding factors.
Conclusions:
Within the limitations of predominantly non-randomized evidence, metal-zirconia implant-supported screw-retained complete-arch prostheses demonstrate a more favorable clinical profile than metal-acrylic prostheses, particularly in terms of prosthetic wear, peri-implantitis, and marginal bone loss. Although overall survival rates were comparable, trends toward improved prosthesis longevity were observed. Well-designed randomized clinical trials with long-term follow-up are required to confirm these findings.
